Provider Demographics
NPI:1710439666
Name:DENTAL ARTS 4 TOTS 2 TEENS LLC
Entity Type:Organization
Organization Name:DENTAL ARTS 4 TOTS 2 TEENS LLC
Other - Org Name:POINT PLEASANT DENTISTRY FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-202-7114
Mailing Address - Street 1:3824 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2054
Mailing Address - Country:US
Mailing Address - Phone:732-202-7114
Mailing Address - Fax:732-202-7191
Practice Address - Street 1:3824 RIVER RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2054
Practice Address - Country:US
Practice Address - Phone:732-202-7114
Practice Address - Fax:732-202-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ220DI023492001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0170216Medicaid